Provider Demographics
NPI:1265427959
Name:LANG, CONNIE ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:ELIZABETH
Last Name:LANG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 SE 6TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66607-2209
Mailing Address - Country:US
Mailing Address - Phone:785-354-8909
Mailing Address - Fax:785-354-8202
Practice Address - Street 1:3444 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66607-2209
Practice Address - Country:US
Practice Address - Phone:785-354-8909
Practice Address - Fax:785-354-8202
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS350054428Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KSU74028Medicare UPIN
KS060908Medicare ID - Type Unspecified